Congo Ebola total grows to 52 as security concerns hamper epidemic containment efforts

CIDRAP reports that one of the cases from Mangina reported yesterday is a health worker from the Mangina Reference Health Center, the health ministry said in its statement yesterday. About 74 of the health center’s staff members have been identified as contacts of Ebola cases have been have been temporarily discharged and will be monitored for twenty-one days, the health ministry said in its 11 August statement.

As another response step, the ministry said it has finalized a plan through a World Bank-funded project to offer free healthcare in three health zones around the outbreak epicenter—Mabalako, Blessed, and Oicha—to remove financial barriers to care and encourage resident to seek care as soon as the first Ebola symptoms appear.

In Twitter posts Monday, Peter Salama, the WHO’s deputy director-general of emergency response, said sadly, many health workers in Mangina were exposed to Ebola early in the outbreak. And since health worker infections are known to amplify Ebola outbreaks, health officials expect the current DRC outbreak to get worse before it gets better. “Given complexities, we ask all partners to support government-led response with their most experienced staff,” he said.

Salama said the event is on an “epidemiological precipice” and that there’s a crucial time-limited window of opportunity to prevent the Ebola outbreak from taking hold in areas that are much more difficult to access due to security concerns. “There is not a minute to lose,” he said.

Authorities to deploy experimental antibody treatment
Health officials are preparing to use an experimental antibody treatment called mAB114 in the latest outbreak Steve Ahuka, a virologist from the DRC’s National Institute for Biomedical Research (INRB) told Reuters on Aug 11.

The monoclonal antibody treatment was developed in the United States and is based on antibodies of a patient who survived Ebola during an outbreak in the DRC city of Kikwit in 1995, according to the Reuters report. Ahuka said the DRC’s ethical committee has approved the use of mAB114 and that it could be used within days. He also said other experimental treatments could also be used.

mAb114 was one of five experimental treatments that the DRC health ministry ethics committee approved for compassionate use during the earlier outbreak, pending finalized study protocol details. In May, a WHO expert group evaluated five therapies—including mAb114—that could be used in the earlier DRC outbreak. It said though early data on mAB114 look promising, more were needed before recommending it for compassionate use.

Remaining vaccine questions, immune response after natural infection
Key scientific questions remain in efforts to develop a safe and effective Ebola vaccine, according to scientists from the Partnership for Research on Ebola Vaccination (PREVAC) who wrote a perspective piece that appeared in the 10 August issue of The Lancet. The team is currently conducting a phase 2 trials in West Africa to evaluate three Ebola vaccination strategies in people age 1 year and older.

In reviewing the status of the wider research landscape, they said 36 trials of Ebola vaccine candidates have been completed and another 14 are active. Focusing on four vaccine candidates (Ad26-ZEBOV, MVA-BN-Filo, chAD3-EBOV, and GamEvac-Combi), they said more data are needed in pregnant women, children, and people with immune compromise, including those with HIV and the elderly. Also, they note that more research is needed on the durability and speed of immune responses prompted by the different vaccine approaches. The team also called for studies to identify correlated of protection and large-scale trials to fully gauge safety and efficacy of the experimental vaccines.

In other medical literature developments, tests on the blood of 15 Ebola survivors found that antibodies from some of them neutralized Ebola viruses from four different strains, as well as Marburg virus. Writing in the Journal of Infectious Diseases Monday, a team from the United States and the DRC they described the experiments they did on the blood of survivors of a 2014 the DRC. Three survivors had a strong response against four filovirus glycoproteins, including that of Marburg virus.

Though they said the mechanism of action of the response requires further study, the data suggest that a pan-filovirus vaccine might be achievable and that it might be possible to isolate human monoclonal antibodies that neutralized all filoviruses.